| 1. |
- Jansson-Frojmark, Markus, et al.
(författare)
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Paradoxical intention for insomnia : A systematic review and meta-analysis
- 2022
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Ingår i: Journal of Sleep Research. - : John Wiley & Sons. - 0962-1105 .- 1365-2869. ; 31:2
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Tidskriftsartikel (refereegranskat)abstract
- Paradoxical intention (PI) has been considered an evidence-based treatment for insomnia since the 1990s, but it has not been evaluated with modern review techniques such as meta-analysis. The present study aimed to conduct the first systematic review and meta-analysis of studies that explore the effectiveness of PI for insomnia on insomnia symptomatology and theory-derived processes. A systematic review and meta-analysis was conducted by searching for eligible articles or dissertations in six online bibliographic databases. Randomised controlled trials and experimental studies comparing PI for insomnia to active and passive comparators and assessing insomnia symptoms as outcomes were included. A random effects model was estimated to determine the standardised mean difference Hedge's g at post-treatment. Test for heterogeneity was performed, fail-safe N was calculated, and study quality was assessed. The study was pre-registered at International Prospective Register of Systematic Reviews (PROSPERO, CRD42019137357). A total of 10 trials were identified. Compared to passive comparators, PI led to large improvements in key insomnia symptoms. Relative to active comparators, the improvements were smaller, but still moderate for several central outcomes. Compared to passive comparators, PI resulted in great reductions in sleep-related performance anxiety, one of several proposed mechanisms of change for PI. PI for insomnia resulted in marked clinical improvements, large relative to passive comparators and moderate compared to active comparators. However, methodologically stronger studies are needed before more firm conclusions can be drawn.
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| 2. |
- Rozental, Alexander, et al.
(författare)
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A psychometric evaluation of the Swedish translation of the Perceived Stress Scale: a Rasch analysis
- 2023
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Ingår i: BMC Psychiatry. - : Springer Nature. - 1471-244X. ; 23
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Tidskriftsartikel (refereegranskat)abstract
- Background: Stress reflects physical and psychological reactions to imposing demands and is often measured using self-reports. A widely-used instrument is the Perceived Stress Scale (PSS), intended to capture more general aspects of stress. A Swedish translation of the PSS is available but has not previously been examined using modern test theory approaches. The aim of the current study is to apply Rasch analysis to further the understanding of the PSS’ measurement properties, and, in turn, improve its utility in different settings.Methods: Data from 793 university students was used to investigate the dimensionality of different version of the PSS (14, 10, and 4 items) as well as potential response patterns among the participants.Results: The current study demonstrates that the PSS-14 has two separate factors, divided between negatively worded items (perceived stress) and positively worded items (perceived [lack of] control), although with only the negative subscale exhibiting good reliability. Response patterns were analyzed using Differential Item Functioning, which did not find an influence of gender on any of the items, but for age regarding the positive subscale (items 6 and 9). The PSS-10 also demonstrated adequate reliability for the negative subscale, but the PSS-4 was not deemed suitable as a unidimensional scale.Conclusions: Based on the results, none of the versions of the PSS should be used by sum-scoring all of the items. Only the negative items from the PSS-14 or PSS-10 can be used as unidimensional scales to measure general aspects of stress. As for different response patterns, gender may nevertheless be important to consider, as prior research has found differences on several items. Meanwhile, content validity is discussed, questioning the relevance of anger and being upset when measuring more general aspects of stress. Finally, a table to convert the PSS-7 (i.e., negative items) ordinal sum scores to interval level scores is provided.
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| 3. |
- Rozental, Alexander, 1985-, et al.
(författare)
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Procrastination Among University Students : Differentiating Severe Cases in Need of Support From Less Severe Cases
- 2022
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Ingår i: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Procrastination refers to voluntarily postponing an intended course of action despite expecting to be worse off for this delay, and students are considered to be especially negatively affected. According to estimates in the literature, at least half of the students believe procrastination impacts their academic achievements and well-being. As of yet, evidence-based ideas on how to differentiate severe from less severe cases of procrastination in this population do not exist, but are important in order to identify those students in need of support. The current study recruited participants from different universities in Sweden to participate in an anonymous online survey investigating self-rated levels of procrastination, impulsivity, perfectionism, anxiety, depression, stress, and quality of life. Furthermore, diagnostic criteria for pathological delay (PDC) as well as self-report items and open-ended questions were used to determine the severity of their procrastination and its associated physical and psychological issues. In total, 732 participants completed the survey. A median-split on the Pure Procrastination Scale (PPS) and the responses to the PDC were used to differentiate two groups; “less severe procrastination” (PPS ≤ 2.99; n = 344; 67.7% female; M age = 30.03; SD age = 9.35), and “severe procrastination” (PPS ≥ 3.00; n = 388; 66.2% female; M age = 27.76; SD age = 7.08). For participants in the severe group, 96–97% considered procrastination to a problem, compared to 42–48% in the less severe group. The two groups also differed with regard to considering seeking help for procrastination, 35–38% compared to 5–7%. Participants in the severe group also reported more problems of procrastination in different life domains, greater symptoms of psychological issues, and lower quality of life. A thematic analysis of the responses on what physical issues were related to procrastination revealed that these were characterized by stress and anxiety, e.g., tension, pain, and sleep and rest, while the psychological issues were related to stress and anxiety, but also depression, e.g., self-criticism, remorse, and self-esteem. The current study recommends the PPS to be used as an initial screening tool, while the PDC can more accurately determine the severity level of procrastination for a specific individual.
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| 4. |
- Buhrman, Monica, 1974-, et al.
(författare)
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Treating perfectionism using internet-based cognitive behavior therapy : A study protocol for a randomized controlled trial comparing two types of treatment
- 2020
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- Perfectionism is characterized by setting high standards and striving for achievement, sometimes at the expense of social relationships and wellbeing. Despite sometimes being viewed as a positive feature by others, people with perfectionism tend to be overly concerned about their performance and how they are being perceived by people around them. This tends to create inflexible standards, cognitive biases, and performance-related behaviors that maintain a belief that self-worth is linked to accomplishments. Cognitive behavior therapy has been shown to be a viable treatment for perfectionism, both in terms of reducing levels of perfectionism and improving psychiatric symptoms. Furthermore, a number of recent studies indicate that it can be successfully delivered via the Internet, both with regular support and guidance on demand from a therapist. In the present study protocol, a clinical trial for perfectionism is described and outlined. In total, 128 participants will be recruited and randomized to either a treatment that has already been demonstrated to have many benefits, Internet-based Cognitive Behavior Therapy for perfectionism (iCBT-P), or an active comparison condition, Internet-based Unified Protocol (iUP), targeting the emotions underlying depression and anxiety disorders. The results will be investigated with regard to self-reported outcomes of perfectionism, psychiatric symptoms, self-compassion, and quality of life, at post-treatment and at six- and 12-month follow-up. Both iCBT-P and iUP are expected to have a positive impact, but the difference between the two conditions in terms of their specific effects and adherence are currently unknown and will be explored. The clinical trial is believed to lead to a better understanding of how perfectionism can be treated and the specificity of different treatments.
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| 5. |
- Forsström, David, 1981-, et al.
(författare)
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A study protocol of a randomized controlled study of internet-based cognitive behavioral therapy for adult attention deficit hyperactivity disorder
- 2023
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 33
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Tidskriftsartikel (refereegranskat)abstract
- Attention deficit hyperactivity disorder (ADHD) is a disorder characterized by hyperactivity, impulsivity and lack of attention. It can have a major impact on everyday life and result in negative consequences for one's personal, academic, and work situation. For individuals with symptoms of ADHD, increased levels of anxiety and depression are common, and an overall reduction of quality of life is often present. This study protocol describes a clinical trial of internet-based cognitive behavioral therapy (iCBT), using a randomized controlled study design, with the primary aim to increase quality of life, as well as to reduce symptoms of ADHD, anxiety, depression, and stress. A second aim is to investigate, by qualitative means, what aspects of treatment were perceived as helpful and hindering when it comes to completing iCBT. Two hundred participants with symptoms of ADHD will be included and randomized to two conditions (treatment and wait-list control). The treatment period is comprised of a maximum of ten weeks, with two mandatory modules and ten modules from which the participants can choose freely. Self-report measures will be completed by the participants at baseline and end of treatment, as well as at a six-month follow-up. The treatment is guided by therapists and consists of weekly correspondence with the participants. The study will utilize an intention to treat design, with ANOVAs and Reliable Change Index to evaluate treatment effects. The qualitative part of the project will be interview-based and employ thematic analysis. Lastly, a psychometric evaluation of a common instrument for determining ADHD-symptoms will also be made. The results will hopefully contribute to the evidence base for iCBT for individuals with symptoms of ADHD and help disseminate potentially effective interventions.
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| 6. |
- Forsström, David, 1981-, et al.
(författare)
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Psychometric properties of the Jonsson-Abbott Scale : Rasch and confirmatory factor analyses
- 2022
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Ingår i: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Measuring and assessing the different aspects of gambling behavior and its consequences is crucial for planning prevention, treatment, and understanding the development of at-risk and problem gambling. Studies indicate that instruments measuring problem gambling produce different results based on the characteristics of the population assessed. To accurately measure at-risk and problem gambling behavior, especially in a low-risk population, measures must cover a wider set of dimensions than the negative consequences already manifest. The Jonsson-Abbott Scale (JAS) includes items that cover overconsumption, actions that reinforce gambling behavior, and belief in gambling fallacies, based on a three-factor structure and has previously demonstrated good psychometric properties. However, there is a need to investigate how the instrument also functions in low-risk populations. This study aims to do so using both confirmatory factor and Rasch analysis; this research included 1,413 Swedish participants who endorsed at least one JAS item. The results replicated the previous three-factor solution and indicated that the instrument had good reliability. In addition, the results demonstrated that the three factors are independent, and the overall score per factor needs to be analyzed. In summary, the JAS appears suitable for use in low-risk populations to measure various aspects of gambling behavior.
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| 7. |
- Karyotaki, Eirini, et al.
(författare)
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Do guided internet-based interventions result in clinically relevant changes for patients with depression? : An individual participant data meta-analysis
- 2018
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Ingår i: Clinical Psychology Review. - : Elsevier. - 0272-7358 .- 1873-7811. ; 63, s. 80-92
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Forskningsöversikt (refereegranskat)abstract
- Little is known about clinically relevant changes in guided Internet-based interventions for depression. Moreover, methodological and power limitations preclude the identification of patients' groups that may benefit more from these interventions. This study aimed to investigate response rates, remission rates, and their moderators in randomized controlled trials (RCTs) comparing the effect of guided Internet-based interventions for adult depression to control groups using an individual patient data meta-analysis approach. Literature searches in PubMed, Embase, PsycINFO and Cochrane Library resulted in 13,384 abstracts from database inception to January 1, 2016. Twenty-four RCTs (4889 participants) comparing a guided Internet-based intervention with a control group contributed data to the analysis. Missing data were multiply imputed. To examine treatment outcome on response and remission, mixed-effects models with participants nested within studies were used. Response and remission rates were calculated using the Reliable Change Index. The intervention group obtained significantly higher response rates (OR = 2.49, 95% CI 2.17-2.85) and remission rates compared to controls (OR = 2.41, 95% CI 2.07-2.79). The moderator analysis indicated that older participants (OR = 1.01) and native-born participants (1.66) were more likely to respond to treatment compared to younger participants and ethnic minorities respectively. Age (OR = 1.01) and ethnicity (1.73) also moderated the effects of treatment on remission.Moreover, adults with more severe depressive symptoms at baseline were more likely to remit after receiving intemet-based treatment (OR = 1.19). Guided Internet-based interventions lead to substantial positive treatment effects on treatment response and remission at post-treatment. Thus, such interventions may complement existing services for depression and potentially reduce the gap between the need and provision of evidence-based treatments.
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| 8. |
- Latth, Johanna, et al.
(författare)
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Effects of internet-delivered cognitive behavioral therapy on use of child sexual abuse material : A randomized placebo-controlled trial on the Darknet
- 2022
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 30
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The use of child sexual abuse material (CSAM) is an international public health and child protection challenge.Objective: To investigate whether Prevent It, a therapist-supported, internet-delivered, eight-week, cognitive behavioral therapy, reduces CSAM viewing among users.Methods: We conducted a global online single-blind (participants), parallel-group, superiority, randomized, psychological placebo-controlled trial with a one-month follow-up, 2019-2021 (ISRCTN76841676). We recruited anonymous participants, mainly from Darknet forums. Inclusion criteria: age 18+ years, past week CSAM use, and sufficient English language skills; exclusion criteria: severe psychiatric illness or non-serious intent to participate. The main outcome was change in self-reported, weekly viewing time from pre-to post-treatment, according to the Sexual Child Molestation Risk Assessment+.Results: A total of 160 participants (157 male, 2 non-binary, and 1 not reporting gender) from all world regions (age intervals [%]: 18-29 [49]; 30-39 [30]; 40-49 [15]; 50-59 [6]) were randomized (1:1) to Prevent It (N = 80) or Placebo (N = 80). Between-group, intention-to-treat analyses suggested a significantly larger decrease in viewing time in Prevent It participants vs. controls pre-to post-treatment (Prevent It: N = 76, Placebo: N = 78, estimate-0.25, 95 % CI,-0.46 to-0.04, p = .017, Cohen's d 0.18). Negative side effects from treatment were fewer in Prevent It compared to control participants and neither group reported severe adverse events.Conclusion: We provide initial support for the feasibility, efficacy, and safety of Prevent It to reduce CSAM viewing among motivated users. Further research is needed to validate these findings.
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| 9. |
- Rozental, Alexander, et al.
(författare)
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The Negative Effects Questionnaire : Psychometric Properties of an Instrument for Assessing Negative Effects in Psychological Treatments
- 2019
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Ingår i: Proceedings of the 9th World Congress of Behavioural & Cognitive Therapies. - Tübingen : dgvt-Verlag. - 9783871598517 ; 47:5, s. 559-572
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Psychological treatments provide many benefits for patients with psychiatric disorders, but research also suggest that negative effects might occur from the interventions involved. The Negative Effects Questionnaire (NEQ) has previously been developed as a way of determining the occurrence and characteristics of such incidents, consisting of 32 items and six factors. However, the NEQ has yet to be examined using modern test theory, which could help to improve the understanding of how well the instrument works psychometrically. Aims: The current study investigated the reliability and validity of the NEQ from both a person and item perspective, establishing goodness-of-fit, item bias, and scale precision. Method: The NEQ was distributed to 564 patients in five clinical trials at post-treatment. Data was analyzed using Rasch analysis, i.e., a modern test theory application. Results: 1) the NEQ exhibits fairness in testing across sociodemographics, 2) shows comparable validity for a final and condensed scale of 20 instead of 32 items, 3) uses a rating scale that advances monotonically in steps of 0-4, and 4) is suitable for monitoring negative effects on an item-level. Conclusion: The NEQ is proposed as a useful instrument for investigating negative effects in psychological treatments, and its newer shorter format could facilitate its use in clinical and research settings. However, further research is needed to explore the relationship between negative effects and treatment outcome, as well as to test it in more diverse patient populations
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| 10. |
- Rozental, Alexander, et al.
(författare)
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Treating perfectionism via the Internet: a randomized controlled trial comparing cognitive behavior therapy to unified protocol
- 2024
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Ingår i: Cognitive Behaviour Therapy. - : Taylor & Francis. - 1650-6073 .- 1651-2316. ; 53:3, s. 324-350
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Tidskriftsartikel (refereegranskat)abstract
- Perfectionism can be problematic when your self-worth is dependent on achievements and leads to inflexible standards, cognitive biases, and rigid behaviors. Cognitive behavior therapy for perfectionism is shown to be effective, including for targeting psychiatric symptoms and when delivered via the Internet (iCBT-P). However, few studies have compared it to an active comparator. The current study randomly assigned 138 participants seeking help for perfectionism to iCBT-P or Internet-based Unified Protocol (iUP). Both treatments provided guidance on demand from a therapist and were eight weeks in duration. The results indicated large within-group effects of Cohen’s d 2.03 (iCBT) and 2.51 (iUP) on the Clinical Perfectionism Questionnaire at post-treatment, and maintained effects at 6- and 12-month follow-up, but no between-group difference (β = 0.02, SE = 1.04, p =.98). Secondary outcomes of depression, anxiety, quality of life, self-compassion, procrastination, and stress ranged from small to large, with no differences between the conditions. Both treatments were deemed credible, relevant, of high quality, and well-adhered by the participants. Further research needs to be conducted, but the findings could indicate a lack of specificity, perhaps suggesting there is no need to differentiate between different treatments that are transdiagnostic in nature.
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